Antecedent of pregnancy-related cardiometabolic complication and risk of cardiovascular disease among women with type 2 diabetes

Aim — We investigated the contribution of antecedent gestational diabetes mellitus (GDM) or gestational hypertensive disorder (GHTD) to the risk of cardiovascular disease (CVD) among women with Type 2 diabetes mellitus (T2DM).

Methods — In a population-based cohort using the Ministry of Health of Ontario (Canada) healthcare administrative data, women without prior CVD with T2DM and a history of GDM or GHTD as of 1 January 2018 (n = 11 525, mean age: 43 years) were age-matched to three comparator cohorts (women with T2DM and no history of GDM or GHTD [n = 11 525], women without T2DM and without GDM or GHTD [n = 11 525] and men with T2DM [n = 11 525]). Incident CVD (coronary artery disease [CAD] and cerebrovascular disease) and heart failure (HF) were assessed until 31 December 2023.

Results — There were 1231 CVD events over a median follow-up of 6 years. Compared to women with T2DM but no history of GDM or GHTD, women with T2DM and a history of GDM or GHTD exhibited higher incident CVD (adjusted hazard ratio [aHR]: 1.19, 95% CI: 1.01, 1.41) and CAD (aHR: 1.35, 95% CI: 1.10, 1.66) risks. They also had higher CVD (aHR: 3.70, 95% CI: 2.79, 4.91), CAD (aHR: 4.96, 95% CI: 3.43, 7.19), cerebrovascular disease (aHR: 2.41, 95% CI: 1.54, 3.76) and HF (aHR: 4.95, 95% CI: 2.05, 11.94) risks versus women without T2DM and no history of GDM or GHTD. However, they had lower CVD, CAD, cerebrovascular disease and HF risks, compared to men with T2DM.

Conclusions — Among women with T2DM, prior GDM or GHTD conferred a higher CVD risk.